Using LEAN principles to improve quality, patient safety, and workflow in histology and anatomic pathology.

Histology and anatomic pathology have historically been slow to accept many of the process changes that have been widely accepted in the clinical laboratory. In this article, we describe the application of the Toyota Production System (LEAN) to histology and anatomic pathology as implemented at the Avera McKennan Hospital laboratory. Avera McKennan is the flagship hospital of the Avera Health System, a faith based, not for profit healthcare system based in South Dakota. Comprised of 235 hospitals, clinics, and physicians, with over 12,000 employees, Avera Health is one of the largest healthcare systems in the region. Beginning in 2004, Avera McKennan's laboratory began its "LEAN journey" and in the intervening years has expanded it throughout all areas of the laboratory. Following the example set by the laboratory, many other areas of the hospital have joined in the LEAN Process Improvement journey. In January 2009, the Avera McKennan Laboratory became the first hospital laboratory in the US to achieve the CAP ISO-15189 accreditation in both clinical and anatomic pathology.

Historical development of the renal histopathology services in Malaysia.

Western-style medicine was introduced to Malaya by the Portuguese, Dutch and British between the 1500s and 1800s. Although the earliest pathology laboratories were developed within hospitals towards the end of the 19th Century, histopathology emerged much later than the biochemistry and bacteriology services. The University Departments of Pathology were the pioneers of the renal histopathology diagnostic services. The Department of Pathology, University of Malaya (UM) received its first renal biopsy on 19 May 1968. Hospital Universiti Kebangsaan Malaysia (HUKM) and Hospital Universiti Sains Malaysia (HUSM) started their services in 1979 and 1987 respectively. It is notable that the early services in these University centres caterred for both the university hospitals and the Ministry of Health (MOH) until the mid-1990s when MOH began to develop its own services, pivoted on renal pathologists trained through Fellowship programmes. Currently, key centres in the MOH are Kuala Lumpur Hospital, Sultanah Aminah Hospital Johor Bahru and Malacca Hospital. With the inclusion of renal biopsy interpretation in the Master of Pathology programmes, basic renal histopathology services became widely available throughout the country from 2000. This subsequently filtered out to the private sector as more histopathologists embraced private practice. There is now active continuing professional development in renal histopathology through clinicopathological dicussions, seminars and workshops. Renal research on amyloid nephropathy, minimal change disease, IgA nephropathy, fibrillary glomerulonephritis, lupus nephritis and microwave technology have provided an insight into the patterns of renal pathology and changing criteria for biopsy. More recently, there has been increasing involvement of renal teams in clinical trials, particularly for lupus nephritis and renal transplant modulation.

A new paradigm for teaching histology laboratories in Canada's first distributed medical school.

To address the critical problem of inadequate physician supply in rural British Columbia, The University of British Columbia (UBC) launched an innovative, expanded and distributed medical program in 2004-2005. Medical students engage in a common curriculum at three geographically distinct sites across B.C.: in Vancouver, Prince George and Victoria. The distribution of the core Histology course required a thorough revision of our instructional methodology. We here report our progress and address the question "How does one successfully distribute Histology teaching to remote sites while maintaining the highest of educational standards?" The experience at UBC points to three specific challenges in developing a distributed Histology curriculum: (i) ensuring equitable student access to high quality histological images, (ii) designing and implementing a reliable, state-of-the-art technological infrastructure that allows for real-time teaching and interactivity across geographically separate sites and (iii) ensuring continued student access to faculty content expertise. High quality images--available through any internet connection--are provided within a new virtual slide box library of 300 light microscopic and 190 electron microscopic images. Our technological needs are met through a robust and reliable videoconference system that allows for live, simultaneous communication of audio/visual materials across the three sites. This system also ensures student access to faculty content expertise during all didactic teaching sessions. Student examination results and surveys demonstrate that the distribution of our Histology curriculum has been successful.

Histology: a unique area of the medical laboratory.

Fundamental differences in samples, procedures, nature of results, automation, productivity, staffing levels, and background decision making along work flow and turnaround times characterize histology as a unique area within the medical laboratory. For histology laboratories to function successfully, individual and collective training, well-defined goals, and implemented accountabilities with effective supervision are required. The pathologist, as immediate client of the histology laboratory, has to be involved in the whole operation to assure optimal patient care.

[Dermatohistology laboratory]. / Dermatohistologisches Labor.

Dermatohistology plays an essential role in the diagnosis of cutaneous tumors and inflammatory skin diseases. In order to practice dermatohistology properly, one needs not only a well-equipped laboratory but also properly trained dermatohistologists and laboratory technicians. We discuss the establishment of a dermatohistology laboratory. The technical procedures involved in making slides, ranging from traditional H & E stains, through special stains, immunohistochemistry and molecular-biological techniques, are viewed. The importance of clinical-histologic correlation and the limitations of pure histologic diagnostics are demonstrated with illustrative cases.

Enhancing the dental histology curriculum using computer technology.

The predominant difference between the histology offered to dental students and that taken by other health care professionals is the emphasis placed on the oral tissues. The oral histology component of the dental curriculum is commonly handled in one of three ways, all delivering far more detailed information than the often less than one hour that a typical medical histology course spends on the oral cavity and its component tissues. Overall, three general curricular styles can be defined: 1) dental histology is taught by medical or dental faculty as a separate course, the oral histology component being a separate course taught by either faculty group; 2) medical and dental students take histology together in a single class with the oral histology component taught separately by faculty from either college; and 3) both basic and oral histology is taught within a single semester, the format used at the University of Kentucky College of Dentistry. The oral histology topics are similar in all of the course formats, regardless of whether they occur as a stand-alone course or are merged with basic histology. The main portion of this paper will describe a self-study, non-microscope-based laboratory experience designed to complement this fused topic course. Self-study labs using digital media are becoming more popular across both medical and dental histology curricula, specifically with the oral histology component where the histological skills for preparing these tissues are rapidly disappearing from many schools. This paper describes a typical syllabus for a fused course, outlining the topics for basic and oral histology, and demonstrates how the laboratory portion has been enhanced using digital technology.